Provider Demographics
NPI:1659598308
Name:JAMAL, NAZREEN
Entity Type:Individual
Prefix:
First Name:NAZREEN
Middle Name:
Last Name:JAMAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FORT WASHINGTON AVE # HP1-104
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3722
Mailing Address - Country:US
Mailing Address - Phone:212-305-4705
Mailing Address - Fax:212-305-4705
Practice Address - Street 1:180 FORT WASHINGTON AVE # HP1-104
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-4705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12694208000000X
NY276729207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12/29/2008OtherTUFTS HEALTH PLAN
RI007060580OtherRI MEDICARE
RI02/12/2009OtherNHPRI
RI1659598308OtherNPI
RI12/08/2008OtherBCBSRI
RINJ72970Medicaid